Prevention of spinal cord ischemia in surgery of thoraco-abdominal aneurysms. The Bio Medicus pump, the recording of somatosensory evoked potentials and the impact on surgical strategy.
Over a 15-month period 14 consecutive patients underwent surgery for extensive thoracoabdominal aneurysms with a nonheparinized centrifugally pumped (Bio Medicus) bypass and somatosensory evoked potential (SEP) recording. Six patients had a femorofemoral and eight patients a left atrial-common femoral artery bypass. The study aimed to assess the contribution of this approach to the prevention of spinal cord ischemia and the impact of the approach on surgical strategy. All patients survived operation; the 30-day and hospital mortality was 21% (three patients). Two patients became paraplegic. No major cardiac and renal complications occurred. Distal aortic perfusion allowed staged cross-clamping of the aorta in five (35.7%) patients, resulting in a significant reduction in mean spinal cross-clamp time: 23.4 min versus a calculated time of 47.2 min in the same patients if distal aortic perfusion had not been used (p less than or equal to 0.002). In one patient surgical strategy was adjusted during cross-clamping in order to reattach a critical intercostal artery. SEP-derived information confirmed the appropriateness of the surgical strategy in all cases. Whether the spinal cord was protected by this perfusion remained unproven. No bypass-related complications occurred. Distal aortic perfusion and concomitant SEP monitoring offer an improvement of surgical strategy and safer surgery.
de Mol
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B
Academic Medical Center, University of Amsterdam, The Netherlands.
Hamerlijnck
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R
Boezeman
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E
Vermeulen
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FE
D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D001243:Assisted Circulation / Q000295:instrumentation*; D005073:Evoked Potentials, Somatosensory; D005112:Extracorporeal Circulation / Q000295:instrumentation; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008722:Methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010264:Paraplegia / Q000209:etiology / Q000517:prevention & control; D015424:Reperfusion / Q000379:methods; D013116:Spinal Cord / Q000098:blood supply*; D013997:Time Factors